BFAITHFUL
Expert
dr wants to bill 23700, 29826 & 29822 for the following but I disagree. The MUA is inclusive according to CCI & CPT guidelines, however I'm a bit undecided about CPT 29822-59 because I think it looks like it was done for visualization purposes & cleaning out blood clots due to the MUA??
Thanks
DX: Adhesive capsulitis & Chronic impingement syndrome
Procedure: MUA with debridement of glenohumeral joint and bursectomy, acromioplasty and resection of coracoacromial ligament.
GROSS FINDINGS:There was marked restricted motion of the right shoulder during manipulation. There was audible lysis with multiple adhesions. In the glenohumeral joint, there was some bleeding following the manipulation, but the remaining structures seemed to be grossly intact. In the subacromial bursa, there was thickened subacromial bursitis, but somewhat of an anterior acromion spur. At the end of the procedure, this area was cleaned of any excessive bursal tissue and the acromion was flattened. The coracoacromial ligament had been released.
OPERATIVE PROCEDURE:With the patient under right scalene block and sedation, the right shoulder was manipulated with audible lysis of the adhesions and brought through normal range of motion. Following this, the patient was in a beachchair positioner and the right shoulder was properly prepped and draped and arthroscopic arthrotomy carried up in the posterior portal. Initially, poor visualization was obtained in the glenohumeral joint, so the arthroscope was directed from the lateral mid portal with the posterior portal used for an accessory portal.
Looking into the subacromial space, the shaving device, the electroblade, was used from the posterior portal and the bursectomy was accomplished as well as the acromioplasty and resection of the coracoacromial ligament. Following this, the instrumentation was redirected into the glenohumeral joint and much better visualization was able to be obtained. There were a number of blood clots from the manipulation, which were irrigated and débrided out. Following this, some Depo Medrol was inserted into the glenohumeral joint to help reduce the inflammatory response and the arthroscopic portals were closed with interrupted sutures of 3 0 nylon. Betadine adaptic compression dressing was applied. The patient returned to the recovery room in satisfactory condition.
Thanks
DX: Adhesive capsulitis & Chronic impingement syndrome
Procedure: MUA with debridement of glenohumeral joint and bursectomy, acromioplasty and resection of coracoacromial ligament.
GROSS FINDINGS:There was marked restricted motion of the right shoulder during manipulation. There was audible lysis with multiple adhesions. In the glenohumeral joint, there was some bleeding following the manipulation, but the remaining structures seemed to be grossly intact. In the subacromial bursa, there was thickened subacromial bursitis, but somewhat of an anterior acromion spur. At the end of the procedure, this area was cleaned of any excessive bursal tissue and the acromion was flattened. The coracoacromial ligament had been released.
OPERATIVE PROCEDURE:With the patient under right scalene block and sedation, the right shoulder was manipulated with audible lysis of the adhesions and brought through normal range of motion. Following this, the patient was in a beachchair positioner and the right shoulder was properly prepped and draped and arthroscopic arthrotomy carried up in the posterior portal. Initially, poor visualization was obtained in the glenohumeral joint, so the arthroscope was directed from the lateral mid portal with the posterior portal used for an accessory portal.
Looking into the subacromial space, the shaving device, the electroblade, was used from the posterior portal and the bursectomy was accomplished as well as the acromioplasty and resection of the coracoacromial ligament. Following this, the instrumentation was redirected into the glenohumeral joint and much better visualization was able to be obtained. There were a number of blood clots from the manipulation, which were irrigated and débrided out. Following this, some Depo Medrol was inserted into the glenohumeral joint to help reduce the inflammatory response and the arthroscopic portals were closed with interrupted sutures of 3 0 nylon. Betadine adaptic compression dressing was applied. The patient returned to the recovery room in satisfactory condition.